Circadian Blood Pressure Profile Research Articles

CHANGES IN THE PARAMETERS OF 24-HOUR BLOOD PRESSURE MONITORING AND ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATED WITH VALSARTAN

Aim. To study changes in the parameters of the 24-hour blood pressure (BP) monitoring and arterial stiffness (AS) in patients with arterial hypertension (HT) and chronic obstructive pulmonary disease (COPD) treated with angiotensin II receptors blocker, valsartan. Material and methods. Men with HT and COPD (n=23), who have been receiving valsartan with starting dose 80 mg/day for 6 months as antihypertensive therapy were included into the study. If target BP was not achieved, correction of the valsartan dose was carried out with the hydrochlorothiazide addition when needed. Clinical examination, 24-hour BP and AS monitoring using BPLab MnSDP-2 monitor ("Petr TELEGIN",Russia), clinical evaluation of COPD were performed. Results. Abnormal circadian BP profile and the elastic properties of arteries were diagnosed in the majority of hypertensive patients with COPD. Valsartan therapy allowed to achieve target BP levels in 100% of patients, normalization of circadian BP profile in 56.5%, improvement in AS parameters: a significant increase in PTT2 (from 89.6±14.3 to 94.4±18.4 ms), reduction of (dP/dt)max (from 566.6±117.9 to 518.8±146.2 mmHg/s), AIx (from -4.0±15.2 to -11.6±20.8 %) as compared to the baseline. Circadian changes in daily parameters of AS in studied patients with the most obvious night-time abnormalities of the elastic properties of arteries were detected. Valsartan intake led to Alx reduction at night-time. Conclusion. Valsartan-based therapy in hypertensive patients with concomitant COPD demonstrated a high antihypertensive efficacy and favorable changes in the elastic properties of the vascular wall that confirm its organoprotective effect.

VASCULAR AND CARDIAC REMODELLING AND COMbINATION THERAPY OF ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC ObSTRUCTIvE PULMONARY DISEASE

Aim. To assess cardiac and vascular structure and function, blood flow parameters, endothelial dysfunction, and cytokine status in patients with arterial hypertension (Ah) and chronic obstructive pulmonary disease (COPD), who were administered combination Co-renitec therapy. Material and methods.The study included 37 patients with Ah and COPD, who underwent laboratory, functional, and ultrasound examination. Results.During the 6-month combination Co-renitec therapy, the parameters of clinical status, circadian blood pressure profile, and endothelial, vascular, and cardiac structure and function were assessed in patients with Ah and COPD. Conclusion. The combination Co-renitec therapy was associated with normalised blood pressure levels, improved clinical and hemodynamic status, cardiac and vascular structure and function, and blood flow and microcirculation, as well as with reduced levels of the markers of endothelial dysfunction and systemic inflammation.

Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers

Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.

ANTIATHEROGENIC AND PLEIOTROPIC ACTIVITY OF VARIOUS DOSES OF ATORVASTATIN IN PATIENTS WITH ISCHEMIC STROKE

Aim. To study the effects of various atorvastatin doses on blood lipids, hemostatic parameters, endothelial function, renin-angiotensin￾aldosterone (RAAS) system, and circadian profile of blood pressure (BP) in patients with ischemic stroke (IS). Material and methods. The study included 34 IS patients (mean age 58,0±6,6 years) with serum levels of low-density lipoprotein cholesterol (LDL-CH) >2,5 mmol/l, arterial hypertension (AH), and BP levels <160/100 mm Hg. All participants were randomised into Groups I and II, which received atorvastatin in daily doses of 10 and 40 mg, respectively, for 12 weeks. The atorvastatin effects on lipid profile, hemostatic parameters, nitric oxide (NO) end products, endothelin-1 (ET-1), angiotensin (AT) II, blood serotonin, and BP dynamics were assessed. Results. After 12 weeks, the patients receiving 10 and 40 mg/d of atorvastatin demonstrated a significant reduction in total CH (by 26,6% (p<0,001) and 33% (p<0,001), respectively), LDL-CH (by 32% (p<0,001) and 44% (p<0,001), respectively), and triglycerides (TG) (by 14% (p<0,001) and 24% (p<0,001), respectively). In both groups, there was no marked dynamics in the initially elevated levels of fibrinogen. In Group I, spontaneous platelet aggregation (PA) reduced by 22,6% (p<0,05). Moreover, in Group I, ADP-induced PA decreased by 16,7% (p<0,05) and 67,2% (p<0,01) for 0,5 and 2 μM of ADP, respectively. In Group II, the respective figures were 30,1% (p<0,05) and 31,6% (p<0,01). The concentration of NO end products increased in both Group I (+15% (p<0,05) after 12 weeks) and Group II (+7,7% (p<0,05) after 6 weeks; +15,5% (p<0,01) after 12 weeks). In all participants (Groups I and II; n=34), atorvastatin therapy was associated with a reduction in ET-1 levels by 4,8% (p<0,05). In Group II, there was a significant reduction in the levels of AT II (-7,1%; p<0,05; n=17) and serotonin (-28,6%; p<0,05; n=11). These changes were accompanied by reduced BP variability, time BP index, and area BP index. Conclusion. In IS patients with hyperlipidemia and AH, atorvastatin demonstrated a dose-dependent lipid-lowering effect on LDL-CH and TG, as well as a dose-dependent pleiotropic activity.

Switching to evening antihypertensive drug dosing improves nighttime blood pressure and dipping status in non-sleepy patients with obstructive sleep apnea

Purpose: Patients with Obstructive Sleep Apnea (OSA) are often hypertensive, and Continuous Positive Airway Pressure (CPAP) may improve at least the circadian profile of blood pressure (BP). As asymptomatic patients with OSA often refuse to follow CPAP treatment, we investigated the efficacy of antihypertensive drug chronotherapy on BP management in this setting. Methods: In a cross-over trial, we studied 40 patients (aged 52±9 years, 77% males) with newly diagnosed hypertension and never treated, at least moderate OSA (apnea-hypopnea index-AHI: 37±20/hour), without daytime sleepiness (Epworth Score ≤10 points). Patients were first applied treatment with valsartan (± amlodipine) in a single morning dose for 8-weeks. In a second period of 8-weeks, patients were assigned to receive the same regimen in a single evening dose before bedtime. Office and ambulatory BP were measured at baseline and after each treatment phase. Based on concurrent start of CPAP application, patients were divided into two groups: on-CPAP (n=19) and off-CPAP (n=21). Results: Office BP was significantly reduced at the end of both the morning and evening dose phases compared to baseline (by 19.5±11.0/15.0±8.6 mmHg and 23.1±11/16.5±8.4 mmHg, repeated measures ANOVA p<0.001). Evening dosing was accompanied by a significant further decrease of office systolic BP (by 3.6±6.5 mmHg, p=0.001) and diastolic BP (by 1.5±4.6 mmHg, p=0.043), compared to morning dosing. The decrease in 24-hour BP was significant but similar in the two dosing times (by 15.7±10.1/10.3±6.2 mmHg and 17.6±9.9/11.3±5.9 mmHg, p<0.001). However, evening compared to morning dosing caused a further reduction in nighttime BP by 4.2±8.4/2.87±5.9 mmHg (p=0.003 and 0.004 respectively). Prevalence of nighttime dipping increased from 32.5% at baseline modestly to 40% with the morning dose and significantly to 62.5% with the evening dose (p=0.001). Split-plot ANOVA revealed that changes in office, ambulatory and nighttime BP were similar between the on- and off-CPAP groups. Conclusions: Evening dosing of antihypertensive treatment effectively improves BP levels and dipping status in non-sleepy patients with OSA, irrespective of application of CPAP.

CIRCADIAN BLOOD PRESSURE PROFILE AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN CHRONIC PROSTATITIS

Objective.To study the relationship between diastolic left ventricular dysfunction and the circadian bloodpressure prof le in patients with chronic prostatitis.Design and methods.Eighty-two patients with chronic prostatitis underwent ambulatory blood pressure monitoring and echocardiography.Results and conclusion.The disturbances of circadian blood pressure profile in patients with chronic prostatitis include the abnormal nocturnal decrease in systolic and/or diastolic blood pressure, instable nocturnal systolic hypertension and an abnormality of the morning blood pressure surge. In patients with abnormal circadian blood pressure profile left ventricular diastolic dysfunction with increased myocardial mass and thickness of the posterior wall of the left ventricle was more prevalent.

THE BENEFITS OF ANGIOTENSIN II RECEPTOR ANTAGONISTS I TYPE IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

Objective.To assess efficiency of angiotensin II converting enzyme inhibitor Perindopril versus angiotensin II receptor blocker Telmisartan in hypertensive patients with obstructive sleep apnea syndrome (OSAS).Design and methods.Sixty hypertensive patients with OSAS (non-CPAP-users) were enrolled in a randomized controlled open study: 48 males and 12 females; mean age — 56,2 ± 9,5 years; hypertension duration — 12,5 ± 7,4 years; body mass index — 32,0 ± 5,9 kg/m2, apnea-hypopnea index (AHI) — 35,4 ± 24,2 episodes per hour of sleep. All patients were divided into 2 groups: patients (n = 30) from the 1st group got Telmisartan 40 mg daily (titrated up to 80 mg daily if necessary), and Perindopril 4 mg daily (titrated up to 8 mg daily) was prescribed to 2nd group (n = 30). The treatment lasted for 12 weeks. Results.Twenty three patients in Telmisartan group and 24 patients in Perindopril group achieved goal blood pressure (&lt; 140/90 mmHg) (χ2 = 1,23; p &gt; 0,05), all patients got maximal doses of medications. The reduction of offi ce and 24-hour blood pressure was comparable in both groups. Circadian blood pressure profi le was normalized in 17 patients from Telmisartan group and in 9 patients from Perindopril group (χ2 = 6,21; p &lt; 0,05). At the same time AHI decreased by 19 episodes per hour of sleep in Telmisartan group, while it increased by 10,1 episodes per hour of sleep in Perindopril group (p &lt; 0,01).Conclusion.Telmisartan treatment is beneficial in hypertensive obese patients with OSAS compared to Perindopril due to the reduction of OSAS severity (assessed by AHI) leading to the normalization of circadian blood pressure profile.

Prognostic Value of Low Diastolic 24-H Blood Pressure in Type 2 Diabetic Patients in a Follow-Up of 4.7 Years

Background: The prognostic implications of the 24 hours ambulatory blood pressure monitoring (AMBP) have been progressively established but some issues remain controversial about the prognostic value of circadian blood pressure (BP) profile in some high-risk populations, namely the diabetics. Methods: We followed, for 4.7 ± 3.5 years, 262 type 2 diabetic patients without previous cardiovascular events after AMBPs, on the occurrence of a combination of coronary events and stroke. Results: There were 36 events (18 coronary and 18 strokes), 7 of them fatal. Half the population showed a non-dipping pattern (non-dippers plus reverse dippers) and the later conveyed a lower survival rate free from strokes (log rank 6.99; P 75 mmHg) 24H DBP, but not in the group with 24H DBP below 75 mmHg, the 24H systolic BP value was an independent predictor of global events in the multivariate analysis (HR 0.03; 95%CI 0.09 - 0.57; P < 0.002), showing decreased event-free survival in the Kaplan-Meier curves (log rank 9.15; P < 0.003). Conclusion: In our population of diabetic type 2 patients 24H DBP had an impact on prognosis on its own, particularly for its lower values. Thus low values of 24H DBP are associated with high cardiovascular risk. J Endocrinol Metab. 2013;3(1-2):16-23 doi: https://doi.org/10.4021/jem155e

DYNAMICS OF LEFT VENTRICULAR PARAMETERS IN THE LONG-TERM TREATMENT OF RENAL PARENCHYMATOUS ARTERIAL HYPERTENSION

Aim. To investigate the dynamics of left ventricular (LV) parameters during the long-term treatment of renal parenchymatous arterial hypertension (RPAH) in patients with primary chronic glomerulonephritis and preserved renal function.Material and methods. The long-term follow-up included 136 RPAH patients with preserved renal function. Clinical assessment of blood pressure (BP) levels, 24-hour BP monitoring, and Doppler echocardiography (EchoCG) were performed at baseline and during the complex antihypertensive therapy (AHT) and pathogenetic therapy of RPAH patients. The treatment-related dynamics of LV structure and function was evaluated.Results. The long-term complex treatment of RPAH patients resulted in significantly reduced clinical BP levels, improved 24-hour BPM parameters, LV hypertrophy (LVH) regression, and improved diastolic and systolic LV function.Conclusion. The long-term complex AHT, in combination with pathogenetic therapy, resulted not only in reduced BP levels and improved circadian BP profile, but also in improved diastolic and systolic LV function and LVH regression among RPAH patients with preserved renal function.

Effects of various antihypertensive therapy strategies on the circadian blood pressure profile, hemodynamics, and endothelial function in adolescents with essential arterial hypertension

Aim. To assess the effect of graduated physical exercise and extended release indapamide on the main parameters of circadian blood pressure (BP) profile, hemodynamics, and endothelial function in adolescents with Stage I essential arterial hypertension (EAH). Material and methods. The study included 114 adolescent boys with EHA (mean age 16,6±0,12 years) and 27 healthy boys. All EAH patients were divided into three groups. Group I (n=37) included adolescents with labile EAH, according to the 24-hour BP monitoring results. These participants were administered graduated aerobic physical exercise (GAPE). Groups II and III included patients with stable EAH. Group II (n=41) received indapamide retard (Arifon Retard,Servier,France; 1,5 mg once a day, in the morning). Group III (n=36) received the combination of GAPE and indapamide retard. The therapy duration was 6 months. All participants underwent 24-hour BP monitoring, echocardiography, veloergometry (VEM), assessment of endothelial function, and measurement of endothelin-1 levels. Results. In adolescents with Stage I EAH, both labile and stable variants of hypertension were confirmed by the 24-hour BP monitoring data. GAPE improved circadian BP profile, endothelial function, and hemodynamic parameters in patients with labile EAH. In stable EAH, indapamide retard demonstrated a rapid and consistent BP normalisation and improvement in endothelial function, VEM parameters, and endothelin-1 levels. In high-risk patients with EAH, the antihypertensive effect of the combination of GAPE and indapamide retard was comparable to that of indapamide monotherapy. Conclusion. Graduated physical exercise could be used in patients with labile EAH. In adolescents with stable EAH, indapamide retard (as monotherapy and in combination with GAPE) is both effective and safe in normalising circadian BP profile and delivering cardioprotective and vasoprotective effects.

FIVE-YEAR DYNAMICS OF CIRCADIAN BLOOD PRESSURE PROFILE IN FAR NORTH WORKERS WITH ARTERIAL HYPERTENSION

Aim. In a prospective study, to assess the dynamics of circadian profiles of blood pressure (BP) in Far North workers with arterial hypertension (AH) and different shift working patterns. Material and methods. In the first phase of the study (2003–2005), 95 patients with Stage 1–2 AH were examined. Group I included 53 patients who worked only day shifts; Group II included 42 patients who worked alternating day and night shifts. In the second phase (2007–2011), both groups were examined, including 24-hour BP monitoring, and two subgoups (treated vs. untreated AH) were defined. Results. In Far North workers with AH, there was a negative dynamics in circadian BP profile, particularly among night shift workers. AH patients require antihypertensive combination therapy irrespective of their shift working patterns.

Prognostic Value of Low Diastolic 24-H Blood Pressure in Type 2 Diabetic Patients in a Follow-Up of 4.7 Years

Background: The prognostic implications of the 24 hours ambulatory blood pressure monitoring (AMBP) have been progressively established but some issues remain controversial about the prognostic value of circadian blood pressure (BP) profile in some high-risk populations, namely the diabetics. Methods: We followed, for 4.7 ± 3.5 years, 262 type 2 diabetic patients without previous cardiovascular events after AMBPs, on the occurrence of a combination of coronary events and stroke. Results: There were 36 events (18 coronary and 18 strokes), 7 of them fatal. Half the population showed a non-dipping pattern (non-dippers plus reverse dippers) and the later conveyed a lower survival rate free from strokes (log rank 6.99; P &lt; 0.01) as related to the dipper patients, in the Kaplan-Meier curves. There was a clear J shaped curve for the distribution of the 24-hour diastolic blood pressure (24H DBP) for global and coronary events, that persisted even after the exclusion of patients with isolated systolic hypertension. Furthermore, in the subgroup with higher (&gt; 75 mmHg) 24H DBP, but not in the group with 24H DBP below 75 mmHg, the 24H systolic BP value was an independent predictor of global events in the multivariate analysis (HR 0.03; 95%CI 0.09 - 0.57; P &lt; 0.002), showing decreased event-free survival in the Kaplan-Meier curves (log rank 9.15; P &lt; 0.003). Conclusion: In our population of diabetic type 2 patients 24H DBP had an impact on prognosis on its own, particularly for its lower values. Thus low values of 24H DBP are associated with high cardiovascular risk. J Endocrinol Metab. 2013;3(1-2):16-23 doi: https://doi.org/10.4021/jem155e

High Incidence of Abnormal Circadian Blood Pressure Profiles in Patients on Steroid Replacement Therapy due to Secondary Adrenal Insufficiency and Congenital Adrenal Hyperplasia without Overt Hypertension - Initial Results

Patients on steroid replacement therapy are at an increased risk of cardiovascular complications owing to the fact that disruptions in the cortisol diurnal rhythm may affect the blood pressure (BP) profile. Aim: To evaluate the circadian BP profiles of patients with secondary adrenal insufficiency (SAI) and congenital adrenal hyperplasia (CAH) on steroid replacement therapy and to compare BP profiles of patients receiving hydrocortisone (HC) in different dosing schedules. Methods: The study included 33 patients: 15 SAI and 18 CAH (mean age 13.2 years 95CI 11.3-15.1). There were no patients with previously diagnosed overt hypertension. Patients with SAI received a mean of 7.39 mg/m2 of HC in 3 daily doses (in the morning (M) 50%, in the afternoon (A) 25%, in the evening (E) 25%), CAH patients 17.9 mg/m2 of HC in the following dosing schedules: 5 patients in 3 equal doses, 7 patients received M: 40% A: 40% E: 20%, the remaining 6 patients had the same dosing schedule as patients with SAI. Fludrocortisone (FC) was given to 13 patients with CAH in 2 equal daily doses. The total dose of HC/FC as well as the dosing schedule of HC was adjusted individually based on clinical and biochemical outcomes. Standard 24-hour BP monitoring (ABPM) was performed using an Ambulatory BP Monitor (Space labs 90217, USA). Results: The majority of the patients (almost 70% SAI, 80% CAH) presented with an abnormal 24-hour BP profile. There were no significant differences in ABPM results between SAI and CAH patients, and no differences between CAH patients treated with and without FC. There was no correlation between HC and FC doses [mg/m2] and ABPM results except that mean night SBP values increased with greater HC doses (r=0.51, p<0.05). Among the CAH group the highest percentage of abnormal ABPM results was observed in patients who received HC in doses: M: 50% A: 25% and E: 25%, the most favorable BP profile was observed in patients with dosing schedule: M: 40%, A: 40%, E: 20%.However there were no significant differences between patients with different treatment protocols, the results suggest that observed disruptions of the BP profile could be related to the HC dosing schedule. Conclusions: The incidence of abnormal BP profiles in patients on steroid replacement therapy due to SAI and CAH without overt hypertension is high. The disruptions of the BP profiles are not associated with the dose of HC or FC. The abnormal BP profiles in patients with SAI or CAH may be related to the HC dosing schedule. 24-hour ABPM seems to be a useful, non-invasive and safe method for the monitoring of HC and FC replacement therapy in patients with adrenal insufficiency. Further investigations in the larger groups of patients are needed.

Role of endothelial dysfunction and circadian blood pressure profile disturbances in the development of cerebrovascular insufficiency among patients with metabolic syndrome

Aim. To assess the role of endothelial dysfunction and circadian blood pressure profile disturbances in the development of cerebrovascular insufficiency among patients with metabolic syndrome (MS). Material and methods. The study included 53 MS patients (8 men and 44 women; mean age 51,6+5,5 years), who underwent brain single-photon emission computed tomography, neuro-psychological assessment, 24-hour blood pressure monitoring (BPM), and brachial artery Doppler ultrasound, in order to assess endothelial function. The control group (12 healthy volunteers) was comparable by age and sex with the main group. Results. MS patients had significantly lower parameters of cognitive function and regional cerebral blood flow (rCBF), compared to controls. At the same, in all patients, a standard neurological examination did not identify any local symptoms. There was a strong association between endothelial function, 24-hour BPM, rCBF, and cognitive status parameters. Conclusion. In MS patients, one of the pathogenetic mechanisms of cognitive dysfunction is a reduction in rCBF, which is linked to endothelial dysfunction and circadian BP profile disturbances.

Comparative effectiveness of the approaches to correct vascular structural and functional disturbances in postmenopausal women

Aim.To compare the effects of Mildronate and hormone replacement therapy (HRT) with estradiol (1 mg) and drospirenone, DSPR (2 mg) on circadian blood pressure (BP) profile, arterial structure and function, and vascular stiffness parameters in women with early postmenopause and climacteric syndrome (CS).Material and methods.The study included 94 women with early postmenopause and CS, who provided written informed consent to participate and were divided into two groups. Group I included 36 women receiving Mildronate (500 mg twice a day), while Group II included 28 women who were administered, according to clinical indications, HRT (1 mg 17β-estradiol and 2 mg DRSP once a day). The control group (CG) included 30 women who did not receive either Mildronate or DRSP. At baseline and 16 weeks later, all participants underwent the assessment of blood biochemistry; intima-media thickness (IMT) of common carotid artery (CCA); endothelium-dependent vasodilatation (EDVD) of brachial artery (BA); antithrombogenic activity of vascular wall; aortal pulse wave velocity (aPWV); arterial stiffness; and 24-hour BP monitoring (BPM).Results.The study demonstrated positive effects of Mildronate therapy and HRT (1 mg 17β-estradiol and 2 mg DRSP) on metabolic status, circadian dynamics and variability (Var) of BP, and arterial structure and function. The largest positive changes in blood lipid profile were observed in Group I and II patients. By the end of the study, these patients demonstrated significantly decreased levels of systolic and diastolic BP and reduced BP Var, particularly in Group II. Mildronate therapy, but not HRT, was associated with normalisation of vascular wall antiaggregant potential. Group II demonstrated a significant reduction in CCA IMT levels, with a similar tendency in Group I. In both groups, the degree of endothelial dysfunction (ED) decreased, which was manifested in increased BA EDVD, decreased aPWV, and reduced arterial stiffness and was more pronounced in Group II.Conclusion.In menopausal women with CS, the effects of Mildronate and HRT on metabolic, structural, and functional disturbances were similar. Therefore, Mildronate therapy could be a new method of correction of these systemic disturbances.

CORRECTION OF COGNITIVE FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION

The study was undertaken to evaluate the effectiveness of angiotensin II receptor antagonist eprosartan according to its effects on blood pressure (BP) and cognitive function in 56 patients with Stage I-II arterial hypertension (AH) associated with light and moderate cognitive disturbances. Six-month monotherapy with eprosartan resulted with multiple beneficial effects: target BP level achievement, circadian BP profile normalization and improvement of some cognitive function (perception, memory and concentration).

Circadian blood pressure profile in hypertensive patients with chronic hepatitis c virus

Circadian blood pressure profile in hypertensive patients with chronic hepatitis c virus

P-238 - Major depression and non-dipping pattern of blood pressure

Major depression has a negative influence on the course and outcome of cardiovascular events. It has been proposed that this association could be explained by higher risk of development of high blood pressure, but studies have produced conflicting results. Although there is no definitive evidence of an association between depression and development of hypertension, depression can impair the management and prognosis of hypertension through several potential mechanisms. Circadian profile of blood pression has been studied as a predictive factor of outcome in hypertensive patients. Studies suggest that non-dipping pattern of blood pressure is associated with worse outcome in these patients. Non dipping pattern of blood pressure has been studied in patients with sleep disorders and it could be associated with reduction of stage 4 sleep and higher percentage of time awake after sleep onset. Sleep disturbances are one of the diagnostic symptoms of major depression and polisomnographic abnormalities have been showed in these patients. The aim of this work is to review the influence of major depression on hypertension course and prognosis, focusing on the circadian profile of blood pressure.

EFFECT OF THE COMBINED ANTIHYPERTENSIVE THERAPY WITH TARGET BLOOD PRESSURE ACHIEVEMENT ON INTRARENAL BLOOD FLOW IN PATIENTS WITH TYPE 2 DIABETES

Aim. To compare the dynamics of intrarenal vascular resistance (IRVR), circadian blood pressure (BP) profile and glomerular filtration rate (GFR) in patients with arterial hypertension (HT) and type 2 diabetes mellitus (DM) who achieved the target BP levels (&lt;130/80 mmHg) due to long-term combined antihypertensive therapy with or without renin-angiotensin-aldosterone system (RAAS) inhibitors. Material and methods. Patients (n=61) with HT and DM without clinical symptoms of nephroangiopathy were included into the open randomized study , 59 of these patients completed study. Patients of Group 1 (n=41) received therapy with valsartan (n=20), 80–160 mg/day , or perindopril (n=21), 5–10 mg/day , in combination with indapamide retard, 1.5 mg/day , and amlodipine, 5–10 mg/day. Patients of Group 2 (n=18) received amlodipine (5–10 mg/day) in combination with indapamide retard (1.5 mg/day) and metoprolol succinate (50–100 mg/day). Initially and after 30–32 weeks of therapy the following examinations were performed: duplex ultrasound scanning of the main renal (MRA) and intrarenal arteries (IRA) with resistive index (RI) calculation, ambulatory BP monitoring (ABPM), GFR calculation (by Cockcroft-Gault formula). Results. The target BP levels were achieved in all patients of both groups. Patient’s baseline characteristics including age, sex, duration of disease, office BP , GFR, RI in MRA and IRA did not differ in the groups as well as decrease in office BP due to treatment. However patients of Group 2 had higher levels of systolic BP and systolic BP load at night time than these in patients of Group 1 during all period of the treatment. In patients of Group 2 RI in MRA and arcuate IRA were increased from 0.67±0.06 to 0.69±0.06 (p=0.02) and from 0.62±0.07 to 0.64±0.06 (p=0.02), respectively. The increase in IRA was positively associated with systolic BP at night time in these patients (r=0.6; p=0.01). There were no significant changes of IRA in Group 1 totally. At the same time, initially high IRVR decreased in 61% of patients. GFR increased in patients of Group 2 (p=0.01), while dynamics of GFR was not found in patients of Group 1. Conclusion. Achievement of target BP levels due to antihypertensive therapy not including RAAS inhibitors resulted in increase in IRVR that associated with the lack of systolic BP reduction at night time.

Masked inefficacy of arterial hypertension treatment: prevalence and predictors

Aim.To assess the prevalence of masked inefficacy of arterial hypertension treatment (AH MTI) and its predictors in various clinical groups and for various blood pressure (BP) control strategies, in order to evaluate the true effectiveness of antihypertensive therapy (AHT).Material and methods.AHT effectiveness was assessed in two groups of the patients with Stage I-II AH (n=219 and n=39), by comparing the ratios of clinical (cl) to ambulatory (a) BP parameters. AH MTI was defined as elevated aBP and target clBP levels during AHT. The potential predictors of AH MTI included gender, age, body mass index (BMI), anamnestic data, frequency of the clinical visits to measure BP, quality of life (QoL) parameters (GWBQ questionnaire), circadian BP profile, orthostatic BP, and ECG signs of left ventricular hypertrophy (LVH).Results.AH MTI prevalence in Groups I and II was 11,0-15,7 % and 22,6-58,1 %, respectively, depending on the definition used. The groups were significantly different in terms of age, BMI, and QoL questionnaire III and VI domains. According to the regression analysis results, in Group I AH MTI was associated with QoL questionnaire II, V, and VI domains, baseline parameters of 24-hour BP monitoring, 24-hour systolic BP (SBP) variability, minimal daytime levels of mean BP, and metoprolol and atenolol therapy. In Group II, AH MTI was predicted by age, BMI, previously administered AHT, alcohol consumption, orthostatic SBP levels, Sokolow-Lyon index, Cornell voltage and Cornell product, Gubner index, and QoL questionnaire I, IV, and VI domains.Conclusion.AH MTI prevalence is associated with some baseline characteristics of the patients and the character of AHT. Due to regression to the mean, AH MTI prevalence could increase substantially when clBP parameters are measured more often.